Female-Patterned Alopecia in Teenage Brothers with Unusual Histologic Features

    August 2006 in “ Journal of Cutaneous Pathology ”
    J Andrew Carlson, Jozef Malysz, Joseph Schwartz
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    TLDR Two teenage brothers had a rare, treatment-resistant form of female-pattern hair loss with unusual scalp changes.
    The document describes a case involving two teenage brothers, aged 15 and 18, who experienced female-patterned androgenetic alopecia (AGA), which is uncommon in males. Despite no findings of metabolic or hormonal abnormalities and unsuccessful treatments with clobetasol, minoxidil, and finasteride, their hair loss progressed. Histological examination showed decreased terminal hairs, a wide range of anagen hair diameters, low terminal to vellus hair ratios (3.7:1 and 3.4:1), and high telogen counts (23% and 21%). Lymphocytic infiltrates around the follicular bulge region were also observed, suggesting an inflammatory variant of AGA or a superimposed condition like alopecia areata. The study suggests that the brothers' hair loss could be a treatment-resistant form of AGA, potentially complicated by other conditions such as cicatricial pattern hair loss, chronic diffuse alopecia areata, or the effects of exogenous androgenic steroids. The findings highlight the complexity in diagnosing hair loss disorders due to the similarity in clinical and histological features.
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